Abstract
In 1980, 1700 people died during a prolonged heat wave in a region under-prepared for heat illness prevention. Dramatically underreported, heat-related pathology contributes to significant morbidity as well as occasional mortality in athletic, elderly, paediatric and disabled populations. Among US high school athletes, heat illness is the third leading cause of death.
Significant risk factors for heat illness include dehydration, hot and humid climate, obesity, low physical fitness, lack of acclimatisation, previous history of heat stroke, sleep deprivation, medications (especially diuretics or antidepressants), sweat gland dysfunction, and upper respiratory or gastrointestinal illness. Many of these risk factors can be addressed with education and awareness of patients at risk. Dehydration, with fluid loss occasionally as high as 6–10% of bodyweight, appears to be one of the most common risk factors for heat illness in patients exercising in the heat. Core body temperature has been shown to rise an additional 0.15–0.2°C for every 1% of bodyweight lost to dehydration during exercise.
Identifying athletes at risk, limiting environmental exposure, and monitoring closely for signs and symptoms are all important components of preventing heat illness. However, monitoring hydration status and early intervention may be the most important factors in preventing severe heat illness.
Similar content being viewed by others
References
Lee-Chiong Jr TL, Stitt JT. Heatstroke and other heat related illnesses: the maladies of summer. Postgrad Med 1995; 98(1): 26–36
Bouchama A, Knochel JP. Heat stroke. N Engl J Med 2002; 346(25): 1978–88
Epstein Y. Heat intolerance: predisposing factors. Med Sci Sports Exerc 1990; 22: 29–35
Nadel ER, Wenger CB, Roberts MF, et al. Physiological defenses against hyperthermia of exercise. Ann N Y Acad Sci 1977; 301: 98–109
Armstrong LE, Epstein Y, Greenleaf JE, et al. American College of Sports Medicine position stand: heat and cold illness during distance running. Med Sci Sports Exerc 1996; 28(12): i–x
Simon H. Hyperthermia. N Engl J Med 1993; 329: 483–7
Werner J. Temperature regulation during exercise: an overview. In: Gisolfi CV, Lamb DR, Nadel ER, editors. Perspectives in exercise science and sports medicine: exercise, heat, and thermoregulation. Dubuque (IA): Brown and Benchmark, 1993; 6: 49–77
Armstrong LE, Maresh CM. The exertional heat illnesses: a risk of athletic participation. Med Exerc Nutr Health 1993; 2: 125–34
Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainer’s Association position statement: fluid replacement for athletes. J Athl Train 2000; 35(2): 212–24
Armstrong LE, Costill DL, Fink WJ. Influence of diuretic-induced dehydration on competitive running performance. Med Sci Sports Exerc 1985; 17: 456–61
Galloway S. Dehydration, rehydration, and exercise in the heat: rehydration strategies for athletic competition. Can J Appl Physiol 1999; 24(2): 188–200
American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Climatic heat stress and the exercising child and adolescent. Pediatrics 2000; 106 (Pt 1): 158–9
Bar-Or O. Temperature regulation during exercise in children and adolescents. In: Gisolfi C, Lamb DR, editors. Perspectives in exercise sciences and sports medicine. Indianapolis (IN): Benchmark Press, 1989: 335–67
Barrow MW, Clark KA. Heat-related illness. Am Fam Physician 1998; 58(3): 749–56
Murray R. Dehydration, hyperthermia, and athletes. J Athl Train 1996; 31: 248–52
Mack G, Nose H, Nadel ER. Role of cardiopulmonary baroreflexes during dynamic exercise. J App Physiol 1988; 65: 1827–32
Hargreaves M, Dillo P, Angus D, et al. Effect of fluid ingestion on muscle metabolism during prolonged exercise. J Appl Physiol 1996; 80(1): 363–6
Pitts GC, Johnson RE, Consolazio FC. Work in the heat as affected by intake of water, salt, and glucose. Am J Physiol 1944; 142: 253–9
Hamilton MT, Gonzalez-Alonso J, Montain SJ, et al. Fluid replacement and glucose infusion during exercise prevents cardiovascular drift. J Appl Physiol 1991; 71(3): 871–7
Convertino VA, Armstrong LE, Coyle EF, et al. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sports Exerc 1996; 28(1): i–vii
Wexler RK. Evaluation and treatment of heat-related illness. Am Fam Physician 2002; 65(11): 2307–14
Mellion MB, Shelton GL. Safe exercise in the heat and heat injuries. In: Mellion MB, Walsh WM, Shelton GL, editors. The team physician’s handbook. Philadelphia (PA): Hanley and Belfus, 1997: 151–65
Heat related illness and deaths: United States, 1994–1995. MMWR Morb Mortal Wkly Rep 1995; 44(25): 465–8
Armstrong LE, De Luca JP, Hubbard RW. Time course of recovery and heat acclimation: ability of prior heat stroke patients. Med Sci Sports Exerc 1990; 22(1): 36–48
Richards D, Richards R, Schofield PJ, et al. Management of heat exhaustion in Sydney’s Sun City-to-Surf run runners. Med J Aust 1979; 2: 457–61
Costrini A. Emergency treatment of exertional heat stroke and comparison of whole body cooling techniques. Med Sci Sports Exerc 1990; 22: 15–8
Armstrong LE, Maresh CM. The induction and decay of heat acclimatisation in trained athletes. Sports Med 1991; 12(5): 302–12
Murray R. Nutrition for the marathon and other endurance sports: environmental stress and dehydration. Med Sci Sports Exerc 1992; 24 (9 Suppl.): S319–23
National Oceanic and Atmospheric Administration [online]. Available from URL: http://weather.noaa.gov/weather/graphics/heatindexchart.jpg [Accessed 2003 Oct 2]
Montain SJ, Coyle EF. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol 1992; 73: 1340–50
Rico-Sanz J, Frontera WR, Rivera MA, et al. Effects of hyperhydration on total body water, temperature regulation and performance of elite young soccer players in a warm climate. Int J Sports Med 1996; 17(2): 85–91
Montreal P, Stark DM, Rildesh ML, et al. Pre-exercise glycerol hydration improves cycling endurance time. Int J Sports Med 1996; 17: 27–33
Greenleaf JE. Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc 1992; 24(6): 645–56
Broad EM, Burke LM, Cox GR, et al. Body weight changes and voluntary fluid intakes during training and competition in team sports. Int J Sport Nutr 1996; 6(3): 307–20
Gisolfi CV, Duchman SM. Guidelines for optimal fluid replacement beverages for different athletic events. Med Sci Sports Exerc 1992; 24(6): 679–87
Maughan RJ, Shirreffs SM. Recovery from prolonged exercise: restoration of water and electrolyte balance. J Sports Sci 1997; 15(3): 297–303
Murray R. The effects of consuming carbohydrate-electrolyte beverages on gastric emptying and fluid absorption during and following exercise. Sports Med 1987; 4(5): 322–51
Fallowfield JL, Williams C. Carbohydrate intake and recovery from prolonged exercise. Int J Sport Nutr 1993; 3(2): 150–64
Armstrong L. Keeping your cool in Barcelona: the effects of heat, humidity, and dehydration on athletic performance, strength, and endurance. Colorado Springs (CO): United States Olympic Committee, 1992: 1–29s
Acknowledgements
No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coris, E.E., Ramirez, A.M. & Van Durme, D.J. Heat Illness in Athletes. Sports Med 34, 9–16 (2004). https://doi.org/10.2165/00007256-200434010-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200434010-00002